Small group of physicians are the highest Medicare billers: 6 key takeaways

A small band of physicians and individual medical providers consistently receive the highest payments from Medicare, according to a recent report from CMS detailing its payments to 950,000 physicians, individual medical providers and certain healthcare companies in 2013.

The records, released June 1, cover $90 billion in payments, including those paid to entities such as clinical laboratories.

The top 1 percent of billers to Medicare in 2013 was paid 17.5 percent ($13.1 billion) of all payments to individual providers for that year, similar to 2012, when the same proportion of physicians and other individual providers took in 16.6 percent of the federal program's payments.

Here are six key takeaways highlighted in the report.

1. The top billers to Medicare range from physicians who provide complex medical care to the sickest patients to those who have expanded the scope of their practices to include expensive laboratory testing or other add-on services, according to The Wall Street Journal.

2. Some physicians saw their payments rise drastically after acquiring new equipment, such as advanced imaging machines, that allow them to bill for services they had previously referred to hospitals. Others began prescribing more expensive drugs.

3. About 70 percent of the approximately $9 billion Medicare paid to individual providers for administering drugs went to the top 1 percent of billers, according to the report.

4. Broken down by specialty, the top billers included in the top 1 percent, beginning with the highest, are:

  • Hematology/oncology
  • Ophthalmology
  • Medical oncology
  • Cardiology
  • Radiation oncology
  • Rheumatology
  • Dermatology
  • Internal medicine
  • Diagnostic radiology
  • Nephrology

5. Some physician practices within the top 1 percent have gained critical attention from regulators. For example, Salomon E. Melgen, MD, an ophthalmologist in Florida, was the No. 3 biller among individual providers in 2013, receiving $14.4 million in payments, lower than in 2012 when he received $21 million. Dr. Melgen, who had close ties to Sen. Robert Menendez (D-N.J.), was indicted on healthcare fraud charges in April. Dr. Melgen's lawyer disputed the charges, attributed his client's high bills to Medicare to costly eye drugs.

6. CMS first released payment records in April 2014 for 2012 data. With the publication this year of 2013 data, the public and healthcare organizations can compare how individual physician and medical providers' billing evolves over time. Furthermore, it could help identify which providers are playing a significant hand in driving the growth of costs, according to The Wall Street Journal. For more information on CMS' hospital and physician payment data, click here.

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